THE PHILIPPINE STAR, Manila,
Tuesday, February 11, 2003.

Until recently, no one—including
doctors—ever bothered to take a closer look at
this issue. We always thought it was a long-answered
question and that it was really medically necessary to
have all males circumcised. But is it?

Circumcision in males usually consists of removing
part of the prepuce or foreskin of the penis. Its
practice has various origins, both religious and
non-religious, medical and non-medical. The reasons for
the practice of circumcision in males have evolved from
biblical practice.

There is still the medical basis, especially for the
Jews and Muslims (but this is not absolute anymore
because there are now Jews and Muslims who object to
male circumcision).

There is still the medical basis, particularly the
belief that circumcision can prevent urinary tract
infection, penile and cervical cancer, and
sexually-transmitted diseases. The sexual arguments for
circumcision are based on the belief that circumcision
offers more sexual enjoyment to both male and female
partners.

However, the predominant driving forces for
circumcision in males are tradition and peer pressure.
Male newborns are circumcised because of the
parents' belief in the traditional practice. Male
adolescents and even adults are also circumcised
because of the traditional need ("passage rite to
manhood") and peer pressure (afraid to be teased as
supot).

An objective, scientific and dispassionate look is
therefore necessary to answer the question: Is
circumcision in males really necessary?

On the basis of medical reasons, routine
circumcision in males is NOT necessary. The American
Academy of Pediatrics has done extensive critical
analysis of all published papers on the topic and has
come out with a stand in 1999
that routine circumcision in males is not
necessary.

On the issue of urinary tract infection, penile and
cervical cancers, circumcision may have a potential
benefit in terms of prevention but its actual value is
minimal because of the low occurrence of these dreaded
consequences. In other words, the risk is extremely low
if circumcision is not done and thus, routine
circumcision is not necessary.

On the issue of sexually-transmitted diseases,
prevention should focus on the behavioral factors
—that is, avoiding promiscuity and careless sex
—rather than relying on circumcision. On the
question of hygiene, promotion can be done with
meticulous mechanical cleansing without having to
resort to the invasive and painful procedure of
circumcision.

The most common and most clear-cut medical
indication for male circumcision is now limited to
patients with urinary infection secondary to phimosis
(extremely small opening of the prepuce or foreskin of
the penis).

Paraphimosis (tightness of the foreskin that tends
to strangle the penis) can be another medical
indication if it occurs. Other than these situations,
medical-wise, circumcision in males is not
necessary.

In the Philippines, the Christian religions do not
require routine circumcision anymore. For the Muslims
and Jews, it may still be advocated but it is no longer
an absolute requirement. There are even websites put up
by Jewish and Muslim authors crusading against
circumcision.

The debatable issue on sexual enjoyment maybe a myth
after all. Although there are no conclusive findings
yet, a most recent scientific article on the issue
shows that more sexual enjoyment is felt by the female
partners with non-circumcised than with circumcised
men. The enjoyment is scientifically validated.

However, not only are the doctors the key opinion
molders in this issue. The voice of the parents and
even the children will be stronger—in fact,
strongest. If they are convinced about the
non-necessity of circumcision, they should also voice
out their stand on it for the sake of their children,
grandchildren, great-grandchildren, and great-great
grandchildren.

* * *

Dr. Reynaldo Joson is chairman of the Department
of Surgery at Ospital ng
Maynila Medical Center. He is a member of the Charter Bureau, a non-stock,
non-profit research foundation, headed by Dr. Rafael
Castillo and based at the Manila Adventist Medical
Center, formerly Manila Sanitarium &
Hospital.